Identification of the landmark registration safe zones during total knee arthroplasty using an imageless navigation system

Derek F. Amanatullah, Paul E. Di Cesare, Patrick A. Meere, Gavin Caesar Pereira

Research output: Contribution to journalArticle

5 Scopus citations


Incorrect registration during computer assisted total knee arthroplasty (CA-TKA) leads to malposition of implants. Our aim was to evaluate the tolerable error in anatomic landmark registration. We incorrectly registered the femoral epicondyles, femoral and tibial centers, as well as the malleoli and documented the change in angulation or rotation. We found that the distal femoral epicondyles were the most difficult anatomic landmarks to register. The other bony landmarks were more forgiving. Identification of the distal femoral epicondyles has a high inter-observer and intra-observer variability. Our observation that there is less than 2. mm of safe zone in the anterior or posterior direction during registration of the medial and lateral epicondyles may explain the inability of CA-TKA to improve upon the outcomes of conventional TKA.

Original languageEnglish (US)
Pages (from-to)938-942
Number of pages5
JournalJournal of Arthroplasty
Issue number6
StatePublished - Jun 2013



  • CA-TKA
  • Computer assisted
  • Landmark registration
  • Navigation
  • Safe zone
  • TKA
  • Total knee arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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